[Intravascular volume expansion and intravenous nimodipine in the treatment of cerebral vasospasm after surgical treatment of intracranial aneurysm].
The advantage of calcium antagonist on cerebral arterial spasm during the peri-operative period has been recently demonstrated. However, the role of volemia and cardiac output in the pathogenesis of arterial spasm seems predominant. The basal hemodynamic profile of 17 patients operated for an intracranial aneurysm was investigated. The hemodynamic and neurological modifications induced by treatment with nimodipine, modification of blood volume and the use of inotropic drug was subsequently analysed. In 8 patients there was a clearcut hypovolemia with diminished cardiac index whereas in 9 other patients there were low filling pressures with an unmodified cardiac index. As early as the 48th hour of treatment, there was an improvement of Hunt and Hess score in 12 patients whereas in 5 others the score remained unchanged. Two death occurred due to the extension of secondary ischemic lesions. This study seems to confirm the aggravating role of hypovolemia in the occurrence of vasospasm and the neurological improvement due to the association of a calcium antagonist, restoration of blood volume with or without a vasoconstrictor.
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Département d'anesthésie réanimation chirurgicale, Hopital B, Centre hospitalier et universitaire, Lille.
Moinardeau
V
V
Riegel
B
B
Lejeune
J P
JP
Fesard
F
F
Debout
J
J
Krivosic-Horber
R
R
D000328:Adult; D002539:Cerebral Arterial Diseases / Q000628:therapy; D004298:Dopamine / Q000627:therapeutic use; D005440:Fluid Therapy / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D002532:Intracranial Aneurysm / Q000601:surgery*; D008875:Middle Aged; D009553:Nimodipine / Q000008:administration & dosage / Q000627:therapeutic use*; D013035:Spasm / Q000503:physiopathology / Q000628:therapy*
D009553:Nimodipine; D004298:Dopamine
Remplissage vasculaire et nimodipine intraveineuse dans le traitement du vasospasme cérébral après cure chirurgicale d'un anévrysme intracranien.